Approximately 20% of older adults report they do not have sufficient care for their activity of daily living (ADL) disabilities. Prior research suggests that subjective assessments of insufficient care are associated with negative health events such as hospitalization, nursing home placement, and mortality. However, it is not known whether subjective assessments provide prognostic information about health outcomes and health care utilization that is not already provided by traditionally measured demographic, resource, health, and functional risks for these outcomes. The specific aims of our proposal are to determine: (1) the unique prognostic significance of subjective assessments of insufficient ADL care on health outcomes and health care utilization; (2) whether there are age, gender and racial/ethnic variations in the prognostic significance of subjective assessments of insufficient ADL care for subsequent health outcomes and health care utilization, and (3) the extent to which type and amount of ADL care received explains the association between subjective assessments of insufficient personal ADL and subsequent health outcomes and utilization. We will conduct this study using data from 5,995 ADL disabled individuals from the 1994, 1999, and 2004 National Long Term Care Survey community assessments. Health outcomes and health care utilization patterns will be determined from linked Medicare claims and vital statistics data. The National Long Term Care Survey is a population-based survey with extensive self-reported information about ADL functioning, help received, health status, and resources for obtaining health care. The results will inform whether subjective assessments of insufficient ADL help complement traditional assessments of need currently used by clinicians, policy makers, and researchers. The results will also inform the public health significance of subjective assessments of insufficient ADL care by assessing whether they are independently associated with excess health burden in a population that is already at high risk for poor health outcomes and high health care utilization. PUBLIC HEALTH RELEVANCE: Approximately 20% of older adults report they do not have sufficient care for their ADL disabilities. The proposed research will determine the unique prognostic value of subjective assessments of insufficient help on future health outcomes and health care utilization. The results of the proposed research will inform whether subjective assessments of insufficient ADL care complement traditional assessments of need currently used by clinicians, policy makers, and researchers.